Definition

Cellulitis is an inflammatory skin disease that affects the middle layer of the skin (dermis) and is caused by bacterial infection. Cellulitis can occur in any area of the body, and is usually preceded by a wound on the skin area and becomes a place for bacterial infection to enter. Cellulitis can cause the affected skin area to swell and become inflamed, and feel painful and hot when touched. The swelling and redness that occurs can spread quickly. In light skin color, cellulitis appears red, while in dark skin color, cellulitis can appear gray to purple.

Cellulitis usually affects the skin areas of the feet and lower limbs, but can also occur on the face, arms, and other skin areas. Bacterial infections from cellulitis can spread to the bloodstream and become life-threatening if not properly managed. The incidence of cellulitis in the United States is 14 million cases annually. Cellulitis usually occurs in young to old adults. There is no significant difference between male and female gender in the incidence of cellulitis.

Cause

The cause of cellulitis is usually an infection from the beta-hemolytic group A streptococcal bacteria, such as the bacteria Streptococcus pyogenes. Bacteria Staphylococcus aureus It is also one of the causes of cellulitis. Cellulitis begins with damage to the skin due to several things, for example:

• Scratched by sharp objects
• Insect bites
• Post-operative wound
• Burn wounds

The presence of wounds on the skin can be a way for bacteria to enter the dermis layer of the skin. The immune system will fight the bacteria and cause an inflammatory (inflammatory) reaction in the affected skin area. In addition, streptococcal bacteria release toxic chemicals that allow bacteria to enter deeper layers to spread to the bloodstream and potentially endanger the soul. Although this disease is caused by bacteria, cellulitis is usually not transmitted from person to person.

Risk Factors

The introduction of several risk factors is very important in the prevention and treatment of cellulitis. Everyone is at risk of getting cellulitis. However, there are several factors that can increase your risk of getting cellulitis.

Some of these risk factors include:

• Wounds or injuries to the skin
  • Animal or insect bites.
  • Surgical wounds
  • Burn wounds
  • Scratch or cut wounds
• Certain medical conditions that can lower the immune system, such as:
  • Diabetes
  • Leukemia
  • HIV/AIDS
  • Taking regular medications with the side effect of decreased immunity
• Blood vessel disorders in the hands or feet, such as varicose veins
• Liver diseases such as hepatitis or cirrhosis
• Other skin diseases such as dermatitis, psoriasis, or skin infectious diseases such as chickenpox or smallpox
• Excess weight
• Having a history of previous cellulitis
• There is swelling in the arms or legs due to impaired lymph gland flow (lymphedema)

Symptoms

Symptoms appear as a response of the body's chemicals to the invasion of foreign bacteria in the dermis. Symptoms that you can feel when you have cellulitis include:

• Redness and swelling of the skin
• Skin is warm and painful to the touch

You are advised to go to the emergency unit if you have some of the following symptoms:

• High fever to chills
• Nausea and vomiting
• The area affected by cellulitis is enlarged and hardened
• The pain felt is getting heavier
• The affected skin area becomes numb or numb

Diagnosis

Diagnosis of cellulitis is a clinical diagnosis, meaning that the doctor can diagnose cellulitis through a special medical interview and a physical examination on you, which can generally be seen through the typical appearance on the skin area affected by cellulitis. However, there are some supporting examinations that can help a doctor to establish a definitive diagnosis of cellulitis.

Some of the supporting examinations include:

• Complete blood count (such as leukocytes and their types) if it is suspected that the infection has spread into the bloodstream
• X-ray examination if there is suspected foreign objects on the skin or bones under the skin area affected by cellulitis
• Blood culture if needed

It is best to tell your doctor if you have ever had cellulitis before. Information such as when the symptoms first appeared will also help the doctor diagnose and determine the best treatment when the patient is first examined by the doctor.

Procedure

Cellulitis requires comprehensive treatment. You are advised to:

• Rest the affected area
• Elevating or raising the affected area of skin to relieve swelling and pain
• Taking over-the-counter pain relievers, such as paracetamol or ibuprofen to relieve pain and also relieve fever if there is

If the existing infection is not serious, you will be asked by the doctor to take antibiotics for a minimum of 5 days. If your infection is a serious infection, you need to be hospitalized and will receive medication through injections until the infection is controlled for about 2 - 3 days. After treatment in a hospital or health facility, it will be continued with drinking medicine at home.

Complications

When someone has cellulitis, complications will arise if the cellulitis is not handled properly. Some complications that can arise include:

• Infections that spread through the blood and cause organ failure (sepsis)
• Infection of the bone (osteomyelitis)
• Infection of the lymphatic vessels (lymphangitis)
• Inflammation of the inner lining of the heart (endocarditis)
• Infection of the membranes that cover the brain and spinal cord (meningitis)
• Tissue death in areas that experience cellulitis (gangrene) can also occur.

In addition, complications such as necrotizing fasciitis also can arise, which is an emergency condition due to skin infection in its deepest layer. The occurrence of recurrent cellulitis can damage the flow of lymphatic drainage which can cause chronic swelling in the area of the leg that has cellulitis.

Prevention

After recognizing some of the risk factors you have, the next step is to improve the risk factors that can be improved. Here are the steps you can take, namely:

• Keep the skin moist with lotion or moisturizer so that the skin is not easily damaged.
• Use shoes that fit your feet and give your feet enough room when wearing shoes
• Cut the toenails as needed without injuring the surrounding skin area.
• Use special protective equipment when exercising.
• Clean with soap and running water slowly accompanied by the application of petroleum jelly if there is damage to the skin
• Cover the injured skin with a plaster and change it every day.
• Watch for signs of infection, such as redness, pain, or swelling
• Don't forget to follow your medication regimen as directed by your doctor.

In addition to the above steps, if you have never seen a doctor, you should do a general examination and if you find a condition or disease that can increase your risk of developing cellulitis, then you can start treatment as early as possible before the condition gets worse.

When should you see a doctor?

If you experience symptoms that resemble cellulitis, or are treating yourself from cellulitis but have additional symptoms such as prolonged fever, drowsiness, weakness, there is a bulge around the cellulitis, or redness that is getting wider, you should see a doctor. specialist in skin and genital (Sp.KK) or specialist in dermatology and venereology (Sp.DV). The doctor will conduct a medical interview, physical examination, to certain supporting examinations to determine the exact diagnosis and the appropriate treatment.

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